Quality of Life Women Breast Cancer Survivors Arm Lymphedema

Cutaneous B-Cell Lymphoma and Lymphedema, Cutaneous T-cell lymphoma and Lymphedema, Hodgkins Lymphoma, Kidney and Renal Cancer, Cervical Cancer, Renal Cell Carcinoma, Breast Cancer, Ovarian Cancer, Testicular, arm swelling, Skin Cancer, angiosarcoma, kaposi's sarcoma, gallium scan, axillary node dissection, gynecological cancer, axillary reverse mapping, lymphatic cancers, inguinal node dissection, cancer treatment, Complete decongestive therapy for arm lymphedema, lymphedema therapy, intensive decongestive physiotherapy, breast cancer related lymphedema, upper limb lymphedema

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Quality of Life Women Breast Cancer Survivors Arm Lymphedema

Postby patoco » Sat Apr 21, 2007 8:26 am

The epidemiology of arm and hand swelling in premenopausal breast cancer survivors.

Cancer Epidemiol Biomarkers Prev. 2007 Apr

Paskett ED, Naughton MJ, McCoy TP, Case LD, Abbott JM.
Ohio State University Comprehensive Cancer Center, A356 Starling-Loving Hall, 320 West 10th Avenue, Columbus, OH 43210, USA. Electra.Paskett@osumc.edu

BACKGROUND: Breast cancer survivors suffer from lymphedema of the arm and/or hand. Accurate estimates of the incidence and prevalence of lymphedema are lacking, as are the effects of this condition on overall quality of life.

METHODS: Six hundred twenty-two breast cancer survivors (age, <or=45 years at diagnosis) were followed with semiannual questionnaires for 36 months after surgery to determine the incidence of lymphedema, prevalence of persistent swelling, factors associated with each, and quality of life.

RESULTS: Of those contacted and eligible for the study, 93% agreed to participate. Fifty-four percent reported arm or hand swelling by 36 months after surgery, with 32% reporting persistent swelling.

Swelling was reported to occur in the upper arm (43%), the hand only (34%), and both arm and hand (22%). Factors associated with an increased risk of developing swelling included having a greater number of lymph nodes removed [hazards ratio (HR), 1.02; P < 0.01], receiving chemotherapy (HR, 1.76; P = 0.02), being obese (HR, 1.51 versus normal weight; P = 0.01), and being married (HR, 1.36; P = 0.05). Factors associated with persistent swelling were having more lymph nodes removed (odds ratio, 1.03; P = 0.01) and being obese (odds ratio, 2.24 versus normal weight; P < 0.01). Women reporting swelling had significantly lower quality of life as measured by the functional assessment of cancer therapy-breast total score and the SF-12 physical and mental health subscales (P < 0.01 for each).

CONCLUSIONS: Lymphedema occurs among a substantial proportion of young breast cancer survivors. Weight management may be a potential intervention for those at greatest risk of lymphedema to maintain optimal health-related quality of life among survivors.

http://cebp.aacrjournals.org/cgi/conten ... t/16/4/775


Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema.

Lymphology. 2006 Dec

Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A.
Department of Internal Medicine, Wroclaw Medical University, Poland.

The aim of this study was to assess disability, psychological
distress and quality of life in Polish breast cancer survivors with
arm lymphedema. One thousand sets of questionnaires consisting of WHO-
DAS II, GHQ-30, EORTC QLQ-C30 and QLQ-BR23 were sent to members of the Polish Federation of Breast Cancer Survivors Clubs "Amazonki."
The response rate was 28.3% of whom 31.70% reported arm lymphedema.

The WHO-DAS II survey showed that patients with arm lymphedema had a higher overall disability score (45.04 versus 38.80 in group without
arm lymphedema; p=0.01) and higher mean values in the scales of
understanding and communicating, getting around, life activities at
home, getting along with people, participating in society. The EORTC
QLQ-C30 survey showed that patients with lymphedema had lower mean
values in physical (0.55 versus 0.65; p=0.001), emotional (0.47
versus 0.57; p=0.01), social (0.59 versus 0. 73; p=0.002), cognitive
and role functioning, increased fatigue, pain, insomnia, dyspnea,
nausealvomiting and financial problems. The EORTC QLQ-BR23 data
demonstrated worse future perspectives and an increase in breast and
arm symptoms, and the GHQ-30 survey produced higher psychological
distress (scores 15.18 versus 11.24; p=0.004). In conclusion, breast
cancer survivors with arm lymphedema were more disabled, experienced
a poorer quality of life and had increased psychological distress in
comparison to survivors without this condition.

PMID: 17319631 [PubMed - indexed for MEDLINE]



Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema.

Support Care Cancer. 2005 Nov

Ridner SH.
Vanderbilt University School of Nursing, Nashville, TN 37240, USA.

OBJECTIVES: The aim of this study was to compare quality of life and symptoms between breast cancer survivors who have developed and
undergone treatment for chronic lymphedema with those who have not
developed lymphedema.

PATIENTS AND METHODS: The cross-sectional,
mixed-methods design included 64 breast cancer survivors with
lymphedema and 64 breast cancer survivors without lymphedema.
Variables assessed quantitatively included sociodemographic
information, medical data, body mass index (BMI), arm extracellular
fluid volume, quality of life (QOL), and physical and emotional
symptoms. For the qualitative component, individuals with lymphedema
responded in writing to the question: During the past week what other
difficulties have you experienced because of your lymphedema?

RESULTS: Compared with those without lymphedema, breast cancer survivors with lymphedema reported poorer QOL. A symptom cluster that included alteration in limb sensation, loss of confidence in body, decreased physical activity, fatigue, and psychological distress was
identified. Perception of limb size influenced the cumulative symptom
experience more than objective arm volume. Qualitative data revealed
multiple QOL, physical health, and psychological concerns. BMI
correlated with multiple outcomes.

CONCLUSIONS: Findings suggest that
current lymphedema treatments, although beneficial, may not provide
complete relief of symptoms associated with lymphedema and
complementary interventions are needed. The poorer QOL in breast
cancer survivors with lymphedema may relate to the presence of an
untreated symptom cluster.

PMID: 15812652 [PubMed - indexed for MEDLINE]



Can Fam Physician. 2005 February 10; 51(2): 247.
Copyright © 2005, Can Fam Physician

Breast cancer-related lymphedema

Women's experiences with an underestimated condition.

Roanne Thomas-MacLean, MA, PHD, Baukje Miedema, MA, PHD, and Sue R. Tatemichi, MD, MSC, CCFP

Correspondence to: Dr R. Thomas-MacLean, Department of Sociology,
University of Saskatchewan, Room 1014, Arts Bldg, 9 Campus Dr,
Saskatoon, SK S7N 5A5; telephone (306) 966-1489; fax (306) 966-6950;
e-mail roanne.thomas@usask.ca

Contributors: Dr Thomas-MacLean was involved in design and conduct of the study and analysis of the data, and was principal author of all drafts of the paper. Dr Miedema was involved in design and conduct of
the study and analysis of the data, and reviewed all drafts of the
paper. Dr Tatemichi was regularly consulted on design and conduct of
the study, participated in analysis of the data, and contributed
substantially to the drafting of the paper.

One distressing health problem facing breast cancer patients is
breast cancer-related lymphedema (BCRL). This incurable condition can
occur many years after treatment is completed and often causes pain
and disability and interferes with work and activities of daily
living. Patients at risk of BCRL are those who have received
radiation therapy or axillary node dissection; higher incidence is
reported among patients who have had both radiation and dissection.
Our objective was to explore New Brunswick women's experiences of
BCRL and its treatment.

A focus group and 15 individual in-depth interviews.

Province of New Brunswick.

A diverse sample of 22 women with BCRL was obtained using age,
location, time after breast cancer diagnosis, and onset of BCRL
symptoms as selection criteria.

The focus group discussion guided development of a semistructured
interview guide that was used for 15 individual interviews exploring
women's experiences with BCRL.

Four themes emerged from the interviews. First, participants thought
they were poorly informed about the possibility of developing BCRL.
Eleven women reported receiving very little or no information about
BCRL. Second, triggers and symptoms varied. Participants used words
such as numb, heavy, tingling, aching, seeping fluid, hard, tight,
limited mobility, and burning to describe symptoms. They reported a
variety of both aggravating and alleviating factors for their
symptoms. Some actions, such as applying heat, were thought to both
exacerbate and reduce symptoms. Third, in New Brunswick, access to
treatment is poor, compression garments are costly, and accessing
physiotherapists is difficult. Last, the effect of BCRL on daily life
is profound: 12 of the 15 women reported that it interfered with work
and day-to-day activities.

Participants were unaware of the risk factors and treatment options
for BCRL. Family physicians should discuss BCRL with their breast
cancer patients routinely. They should be vigilant for the possible
onset of BCRL and, if it is diagnosed, should manage it aggressively
to minimize the severe effect it has on the lives of breast cancer

The full length study can be found at:



Factors associated with arm swelling after breast cancer surgery.

Womens Health (Larchmt). 2003 Nov

Geller BM, Vacek PM, O'Brien P, Secker-Walker RH.
Health Promotion Research, University of Vermont, 1 South Prospect Street, Burlington, VT 05401-3444, USA. berta.geller@uvm.edu

PURPOSE: As life expectancy improves for women with breast cancer, more women will be living with symptoms of lymphedema. This study reports the incidence of arm or hand swelling and associated risk factors in women with invasive breast cancer following surgery.

METHODS: Data were obtained from baseline and follow-up interviews of women with invasive breast cancer (n = 145), and mammography and pathology records. The Kaplan-Meier method was used to estimate the probability of developing arm or hand swelling over time. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for arm or hand swelling.

RESULTS: Of women in this study, 38% self-reported arm or hand swelling. There was a significantly increased risk of arm swelling if women were under 50 years of age, had axillary node dissection, received chemotherapy, worked outside the home, and had a high household income. There was no association of body weight with swelling. A significantly decreased risk of arm swelling was found in women who were on treatment for high blood pressure. After adjustment for nodal dissection, only age had a significant independent effect.

CONCLUSIONS: Our study highlights two important areas of future research that could reduce the incidence of lymphedema. There is a need to better understand the role that treatment for high blood pressure may play in protecting women from arm edema. Second, the potential effect of weight as a modifiable lymphedema risk factor needs to be studied in more detail in light of the conflicting results of different studies.

http://www.liebertonline.com/doi/abs/10 ... 3770948159


Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery.

Breast J. 2004 Sep-Oct

Goffman TE, Laronga C, Wilson L, Elkins D.
Department of Radiation Oncology, Eastern Virginia Medical School, Norfolk 23507, USA. Goffmate@evms.edu

The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment. Clinical, surgical, and radiation-related variables were tested for statistical association with arm and breast lymphedema using regression analyses, t-tests, and chi-squared analyses. Between January 1998 and June 2001, 240 women received radiation for localized breast cancer in our center.

The incidence of lymphedema of the ipsilateral breast, arm, and combined (breast and arm) was 9.6%, 7.6%, and 1.8%, respectively, with a median follow-up of 27 months. For breast edema, t-test and multivariate analysis showed body mass index (BMI) to be significant (p = 0.043, p = 0.0038), as was chi-squared and multivariate testing for site of tumor in the breast (p = 0.0043, p = 0.0035). For arm edema, t-test and multivariate analyses showed the number of nodes removed to be significant (p = 0.0040, p = 0.0458); the size of the tumor was also significant by multivariate analyses (p = 0.0027). Tumor size appeared significant because a number of very large cancers failed locally and caused cancer-related obstructive lymphedema. In our center, even modern, limited level 1-2 axillary dissection and tangential irradiation carries the risk of arm lymphedema that would argue in favor of sentinel node biopsy.

For breast edema, disruption of draining lymphatics by surgery and radiation with boost to the upper outer quadrant increased risk, especially for the obese. Fortunately both breast and arm edema benefited from manual lymphatic drainage.

http://www.blackwell-synergy.com/doi/ab ... 04.21411.x


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